Eye-brain workout

Maybe you don't need glasses. Maybe it's all in your head, and your visual map of the world just isn't matching the real world.

Story By John Darling

Maybe you don't need glasses. Maybe it's all in your head, and your visual map of the world just isn't matching the real world.

It happens to many people and can show up as inability to do homework, function in a crowded room or understand a news report, says optometrist Eric Dukes of Ashland.

To remedy these perceptual "warps" — also called motor- or sensory-integration issues — Dukes puts patients through "developmental optometry," a kind of eye-brain-body workout where you tackle many odd challenges, such as standing on a balance board, interacting with a ball moving on a string, pointing to numbers in a circle around a central point (you can't take your eyes off the central point), walking a maze and keeping track of left and right.

On the maze, patients often report, depending on which way they're facing, that the capital letter B flipped backward, an anomaly that can be fixed in therapy.

"It has nothing to do with visual clarity," says Dukes. "We're dealing with 'What is it?' 'Where is it?' 'How do I get it?' and 'Where am I?' You have to know where you are in space, using the kinesthetic feedback of your ears, eyes and body. The map of the world gets made in the brain, and we're retraining the software of the brain about how to perceive the world."

Dukes works mostly with children who are having trouble with learning and sports, but one adult patient, Paula Johnson of Fort Jones, Calif., says the 12-week therapy changed her life and ended decades of struggle to perceive and understand the world around her.

"I had a hard time on the balance board with the multiple inputs," says Johnson. "There was a disconnect from the world. I would listen to a news report on the radio and couldn't tell you what I just heard. Now I feel I'm participating more effectively in life. I'm reading more. I feel I have a whole new opportunity, a whole new life. Increased self-esteem is a big part of it."

First of all, Dukes, who was educated in the process by the College of Optometrists in Visual Development, takes a case history and puts patients through a 21-point exam, including a standard visual exam to determine, he says, whether the problem is perceptual, motor or refractive.

If it's perceptual or motor issues, says his visual therapist, Christine Clark, "they can manifest as similar to Attention Deficit Hyperactivity Disorder (ADHD), with reports of too much stimulus and difficulty in focusing" — as was the case with Johnson.

"She couldn't follow tracking. Her eyes wouldn't move near to far. They moved differently," says Dukes, noting that, on the balance board, patients are trained to integrate a moving ball with a moving board, then are asked questions to bring in thinking — all with the goal of supporting the brain and eyes to get a match with what's going on in the real world.

Before the therapy, reports Johnson, sensory inputs from the world created a "nebulous sense of stress.

"The words came too fast," she says. "It was impossible to recall them in movies or when getting directions. I ended up feeling stupid and spacey. I backed away from a lot of activities because of the stress."

Dukes notes, "She wasn't grounded in space. She couldn't answer the question 'Where am I?' so she chose jobs that were tactile and kept her literally "in touch" with the world, such as being a massage therapist and gardening.

"Now I don't have to be so kinesthetic all the time," says Johnson. "I can take on challenges and do tests for higher certification. Now I can do paperwork! I never could before. I'd put it off forever.

"It's so exciting."

"We want to allow kids to do what they want," notes Dukes. "Processing information has been very difficult for them, with impossible challenges. We're removing visual roadblocks that impede ability to learn."

Tutoring often is prescribed for such kids, but "it doesn't matter how much tutoring they get if their eyes aren't working properly," says Dukes.

One method for testing the eyes involves a patient looking at a screen with a circle of dots surrounding one dot in the center. If focusing on the center dot makes some of the peripheral dots disappear, Dukes can determine whether the brain is integrating the central with the peripheral — or is letting the peripheral override the central focus. The process increases attention to focus.

Requiring patients to look at beads on two strings (one end of the string against the nose, the other straight out) tells Dukes (if the patient doesn't see both strings) whether both eyes are working together or one eye is shutting down. Using the device as therapy, the patient learns to get his or her eyes working as a team.

In the end, says Dukes, a patient like Johnson will be able to walk into a room "with erect posture, not closed down, and doesn't put her hands against the wall for support. She's less skittish and more sure of herself. She's relying on her vision to tell her where she is."

"I don't have to explain things as much to her," adds Clark. "She retains information better. There's less sitting down and leaning on things. Her world was off a bit. Now her balance has improved immensely."